Knowledge, Attitudes and Practices of Antibiotic Use and Antimicrobial Resistance among Medical Students in a Private University in Dominica, West Indies

Antibiotics are indispensable to maintaining human health, however, their overuse has resulted in resistant organisms which present a significantly higher burden to the low to middle income countries, due to the high incidence of communicable diseases. Insufficient antimicrobial-related training for physicians during their undergraduate education could have a negative impact on their prescribing. This study assessed the knowledge, attitudes and practices of antibiotic use and antimicrobial resistance among medical students in a private university in Dominica, a resource-limited country, in order to facilitate more effective education of these future prescribers. A cross-sectional study was undertaken with the medical students from February 2021 to April 2021 using a 36-item questionnaire. Data analysis was achieved using descriptive statistics. A total of 85 students participated in the study, majority (70%) were female, African, aged 23.8 ± 4.6 years and single. Between 64 and 99% of the respondents reported no risk factors for communicable diseases and demonstrated a low to moderate (10% - 40%) negative response to knowledge-related questions. The majority (70%) of the respondents who had used antibiotics in the past 12 months reported efficacy and limited side-effects, but confirmed lack of knowledge about the classes of antibiotics prescribed to them. Almost half of the medical students (48%) reported having abused antibiotics, while about a third (35%) of the respondents reported sharing antibiotics with friends or loved ones in the past. There was no significant association between age, gender, and the medical students’ knowledge of antibiotic resistance (p > 0.05). However, they reported that they would like more education on antimicrobial use and resistance. The medical students in this study showed knowledge of antimicrobial resistance, but lacked comprehension of components of antimicrobial stewardship, including prevention of inappropriate use and classes of antibiotics. Therefore, steps need to be taken to prepare medical students for antimicrobial resistance and stewardship initiatives effectively.

The Social Context of Antibiotic Resistance

There are various socio-economic （poverty, self medication, and non-compliance to prescribed therapy） and behavior factors that affects the way of antibiotic use, which consequently brings the development of antibiotic resistance in patients. In the study, some of these social factors that might have an impact on the resistance of antibiotics in patients of regional of Vlora hospital during the period 2011-2012 were examined. The study was conducted using structured interviews on patients who were previously examined for bacterial cultures and sensitivity. The antibiotic resistance resulted really high in these patients. It is found out that the organisms with higher resistance were Streptococcus and Escherichia coli. 75% of the patients, whose cultures were positive, were resistant to at least one antibiotic and 31% to three or more antibiotics. A significant correlation between the structure of antibiotic resistance and the upper socio economic levels, the low educational level of the patients, self medication and the frequency of antibiotic use was found. These data have influence in the development of the awareness strategies in risky groups in order to clarify the concepts on the proper use of antibiotics.

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

Did the severe acute respiratory syndrome-coronavirus 2 pandemic cause an endemic Clostridium difficile infection?

BACKGROUND Clostridium difficile infection(CDI)has increased in prevalence during the last years.The coronavirus disease 2019(COVID-19)pandemic has negatively influenced patient outcomes.The majority of the severe acute respiratory syndrome-coronavirus 2(SARS-CoV-2)-infected patients received antibiotics during hospitalization.AIM To analyze the factors that influenced CDI development after SARS-CoV-2 infection.METHODS Between March 2020 to December 2020,we performed a prospective observational study including 447 patients diagnosed with CDI who were admitted to our tertiary referral university hospital.The diagnosis of CDI was based on the presence of diarrhea(≥3 watery stools within 24 h)associated with Clostridium difficile toxins A or B.We excluded patients with other etiology of acute diarrhea.RESULTS Among the total 447(12.5%)patients with CDI,most were male(54.3%)and mean age was 59.7±10.8 years.Seventy-six(17.0%)had history of COVID-19,most being elderly(COVID-19:62.6±14.6 years vs non-COVID-19:56.8±17.6 years,P=0.007),with history of alcohol consumption(43.4%vs 29.4%,P=0.017),previous hospitalizations(81.6%vs 54.9%,P<0.001)and antibiotic treatments(60.5%vs 35.5%,P<0.001),requiring higher doses of vancomycin and prone to recurrent disease(25.0%vs 13.1%,P=0.011).Age over 60 years[odds ratio(OR):2.591,95%confidence interval(CI):1.452-4.624,P=0.001],urban residence(OR:2.330,95%CI:1.286-4.221,P=0.005),previous antibiotic treatments(OR:1.909,95%CI:1.083-3.365,P=0.025),previous hospitalizations(OR:2.509,95%CI:1.263-4.986,P=0.009)and alcohol consumption(OR:2.550,95%CI:1.459-4.459,P=0.001)were risk factors of CDI in COVID-19.CONCLUSION CDI risk is unrelated to history of SARS-CoV-2 infection.However,previous COVID-19 may necessitate higher doses of vancomycin for CDI.

A Royal Jelly Mixture with Berberine for Dressing Change on a Refractory Skin Ulcer:A Case Report

It has been reported that a 92-year-old female had got a bruise superficial wound on her right leg one and a half years ago,developing into refractory skin ulcer due to improper management before.A prepared cream,mixed royal jelly with berberine for dressing change,was made on the scene through the crush of berberine tablets,working with fresh royal jelly.Topical dressing change with the cream was done every 3 days,and two months later,such the ulcer became clean and was covered fully with fresh granulation tissue.This kind of cream consists of the ingredients of TCM purely,free of antibiotic,and being quite effective clinically,also helpful for proper use of antibiotic.

Impact of pharmaceutical intervention on the rational use of antibiotics in primary hospital

Evidence based pharmaceutical interventions focusing on the characteristics of antibiotics use in primary hospitals were investigated to optimize the use of antibiotics. Four pharmaceutical interventions were set up in this study： 1） different levels of antibiotic management system were developed; 2） usage of antibiotics was reported in a monthly journal for the entire hospital; 3） early antibiotics warning system was started; 4） communication between pharmacists and physicians was strengthened. Use of antibiotics in 2007 （before intervention） and 2008 （after intervention） in department of respiratory medicine was analyzed. Significant differences （P〈0.01） in antibiotics use before and after intervention were observed. Use of antibiotics was changed from focusing on one category of drugs to a rotation of a wide range of agents. Evidence based, sound pharmaceutical interventions were effective means to ensure the rational use of antibiotics.